Provider Demographics
NPI:1467038299
Name:MULLETT, ALISON ELAINE (LPC)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:ELAINE
Last Name:MULLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1108
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76503-1108
Mailing Address - Country:US
Mailing Address - Phone:254-773-4022
Mailing Address - Fax:254-773-0919
Practice Address - Street 1:5806 MESA DR STE 300
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3783
Practice Address - Country:US
Practice Address - Phone:512-201-4006
Practice Address - Fax:254-773-0919
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80224101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80224OtherSTATE LICENSE